NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales |
ATI-Inspired Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old man is admitted with worsening hypertension. His
history includes type 2 diabetes mellitus, chronic kidney disease
(stage 3), and a previous myocardial infarction. Current
medications include aspirin, atorvastatin, and metformin. Vital
signs are BP 178/96 mm Hg, HR 78/min, RR 18/min, SpO₂ 98%
on room air. Laboratory results reveal potassium 4.3 mEq/L,
creatinine 1.8 mg/dL, and estimated GFR 42 mL/min/1.73 m².
The provider prescribes lisinopril.
Question Stem
Which assessment finding should the nurse identify as the
highest priority to monitor after initiating lisinopril therapy?
A. Development of a persistent dry cough
,B. Blood pressure reduction within 24 hours
C. Sudden swelling of the lips and tongue
D. Mild dizziness when standing quickly
Correct Answer
Correct Answer: C. Sudden swelling of the lips and tongue
Detailed Rationale
Angiotensin-converting enzyme (ACE) inhibitors such as
lisinopril reduce blood pressure by inhibiting conversion of
angiotensin I to angiotensin II, resulting in vasodilation and
decreased aldosterone secretion. Although highly effective for
hypertension, heart failure, diabetic kidney disease, and post-
myocardial infarction patients, ACE inhibitors can rarely cause
angioedema, characterized by swelling of the lips, tongue, face,
or airway. Angioedema is potentially life-threatening because
airway obstruction can develop rapidly. The nurse should
immediately discontinue the medication, maintain the airway,
and notify the provider.
Option A: A dry cough is a common adverse effect caused by
increased bradykinin levels. Although bothersome, it is
generally not an emergency and may require changing to an
angiotensin receptor blocker (ARB).
,Option B: Blood pressure reduction is the desired therapeutic
effect and should be monitored but is not the highest priority
compared with airway compromise.
Option D: Mild orthostatic dizziness is relatively common,
particularly during initial therapy. Patients should be instructed
to rise slowly, but this finding is less urgent than angioedema.
The nurse should also monitor renal function and serum
potassium because ACE inhibitors may worsen renal
impairment or cause hyperkalemia, especially in patients with
chronic kidney disease.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize life-threatening adverse effects of ACE
inhibitors.
• Prioritize nursing interventions for airway emergencies.
• Monitor renal function and potassium during ACE inhibitor
therapy.
• Differentiate expected from serious adverse effects.
Medication Safety Focus
Adverse Effect Recognition
, Question 2
Clinical Scenario
A 74-year-old woman with chronic heart failure receives digoxin
0.125 mg orally each morning. She reports nausea, poor
appetite, and seeing yellow halos around lights. Assessment
reveals HR 52/min, BP 108/64 mm Hg, RR 18/min. Laboratory
values include potassium 3.0 mEq/L and creatinine 1.5 mg/dL.
Question Stem
Which nursing action is the priority?
A. Administer the scheduled digoxin dose.
B. Hold the digoxin and notify the provider.
C. Encourage increased oral fluid intake.
D. Administer an antacid for nausea.
Correct Answer
Correct Answer: B. Hold the digoxin and notify the provider
Detailed Rationale
Digoxin increases myocardial contractility while slowing
conduction through the atrioventricular node. Because it has a
narrow therapeutic index, careful monitoring is essential. This
client demonstrates classic findings consistent with digoxin
toxicity: bradycardia, nausea, anorexia, visual disturbances
Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales |
ATI-Inspired Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old man is admitted with worsening hypertension. His
history includes type 2 diabetes mellitus, chronic kidney disease
(stage 3), and a previous myocardial infarction. Current
medications include aspirin, atorvastatin, and metformin. Vital
signs are BP 178/96 mm Hg, HR 78/min, RR 18/min, SpO₂ 98%
on room air. Laboratory results reveal potassium 4.3 mEq/L,
creatinine 1.8 mg/dL, and estimated GFR 42 mL/min/1.73 m².
The provider prescribes lisinopril.
Question Stem
Which assessment finding should the nurse identify as the
highest priority to monitor after initiating lisinopril therapy?
A. Development of a persistent dry cough
,B. Blood pressure reduction within 24 hours
C. Sudden swelling of the lips and tongue
D. Mild dizziness when standing quickly
Correct Answer
Correct Answer: C. Sudden swelling of the lips and tongue
Detailed Rationale
Angiotensin-converting enzyme (ACE) inhibitors such as
lisinopril reduce blood pressure by inhibiting conversion of
angiotensin I to angiotensin II, resulting in vasodilation and
decreased aldosterone secretion. Although highly effective for
hypertension, heart failure, diabetic kidney disease, and post-
myocardial infarction patients, ACE inhibitors can rarely cause
angioedema, characterized by swelling of the lips, tongue, face,
or airway. Angioedema is potentially life-threatening because
airway obstruction can develop rapidly. The nurse should
immediately discontinue the medication, maintain the airway,
and notify the provider.
Option A: A dry cough is a common adverse effect caused by
increased bradykinin levels. Although bothersome, it is
generally not an emergency and may require changing to an
angiotensin receptor blocker (ARB).
,Option B: Blood pressure reduction is the desired therapeutic
effect and should be monitored but is not the highest priority
compared with airway compromise.
Option D: Mild orthostatic dizziness is relatively common,
particularly during initial therapy. Patients should be instructed
to rise slowly, but this finding is less urgent than angioedema.
The nurse should also monitor renal function and serum
potassium because ACE inhibitors may worsen renal
impairment or cause hyperkalemia, especially in patients with
chronic kidney disease.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize life-threatening adverse effects of ACE
inhibitors.
• Prioritize nursing interventions for airway emergencies.
• Monitor renal function and potassium during ACE inhibitor
therapy.
• Differentiate expected from serious adverse effects.
Medication Safety Focus
Adverse Effect Recognition
, Question 2
Clinical Scenario
A 74-year-old woman with chronic heart failure receives digoxin
0.125 mg orally each morning. She reports nausea, poor
appetite, and seeing yellow halos around lights. Assessment
reveals HR 52/min, BP 108/64 mm Hg, RR 18/min. Laboratory
values include potassium 3.0 mEq/L and creatinine 1.5 mg/dL.
Question Stem
Which nursing action is the priority?
A. Administer the scheduled digoxin dose.
B. Hold the digoxin and notify the provider.
C. Encourage increased oral fluid intake.
D. Administer an antacid for nausea.
Correct Answer
Correct Answer: B. Hold the digoxin and notify the provider
Detailed Rationale
Digoxin increases myocardial contractility while slowing
conduction through the atrioventricular node. Because it has a
narrow therapeutic index, careful monitoring is essential. This
client demonstrates classic findings consistent with digoxin
toxicity: bradycardia, nausea, anorexia, visual disturbances
